Reforming the physician reimbursement system is a recurring theme here, as the perverse incentives of a fee-for-service system is a primary driver of health care costs.
Any talk about comparing US physician salaries with those abroad has to be accompanied by the context of the larger medical school debt and malpractice insurance that American physicians face.
So, would you accept lower physician salaries in exchange for a fully subsidized medical school education? Maggie Mahar speculates:
I suspect that many doctors would be happy with the trade-off. In terms of quality of life, many would consider being debt-free when they graduated in their early 30s more important than making 16 to 20 percent more when they were 57″”especially if they didn’t have to rush through their appointments in order to make their numbers. Again, doctors themselves are not happy to be laboring in a health care system where they are rewarded for doing more rather than for taking better care of their patients. Most physicians are as frustrated as their patients by the hurried appointments and lack of real communication between doctor and patient.
Read the rest of her excellent analysis of physician salaries.
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- School debt influences the career choice of medical students
- Free medical school
- Medical school debt and political views
- Free medical school for students who choose primary care?
- Would you trade your salary for free medical school and "tort-adverse" malpractice?
- Medical school debt
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{ 13 comments }
Reimburse: 1. to pay back to someone 2. to make restoration or payment of an equivalent to (reimburse an agent for his traveling expenses) This is copied from Webster’s.
I think you should be using the word “fee” rather than “reimbursement” when talking about physician compensation.
I’m a current medical student and this would not make me happy. That is robbing Peter to pay Paul. I want my medical school to be paid for and make the same amount of money. The truth of the matter is that I am giving up something much more precious than 150-200K in loans: my 20s. Do you know how many friends medical school has cost me. All of my law school friends, business friends, etc. all go out together whereas I am stuck studying every weeknight and weekend with the rest of the medical students I know. I am giving up the prime of my life and I won’t be able to show a cent for it. Now I would prefer to come out with no debt, but I would rather have 17 percent more income for 35 years of working then the 150K in my pocket right now. There is opportunity cost and life cost that outweighs the money cost of medical school.
Anyone who would agree to this deal this obviously is not all that smart unless they are going to graduate medical school when they are 60 years old and practice for about 5 years. Then it would be a good deal.
Funny that I just read this.
My issue with her analysis of American vs foreign incomes is that most people don’t compare themselves to someone across the world. They compare themselves to the guy next door or the college roommate who went into finance.
If all you want is money then you need to go into another career.
I would be curious to see how American lawyer salaries compare with those in France or other countries abroad.
Perhaps an argument can be made that most every American profession is “overpaid” when compared to European countries.
I think 16% reduction is too much – my back of the envelope calculations show that it would not be worth it for an average med student. I think 6% or 7% is more like it. Of course, it will be a different calculation for each person depending on the accumulated debt and expected average salary.
I was going to leave a comment for anonymous 12:03 p.m., something to the effect that many people in their 20s, besides medical students, have to make sacrifices. There are no guarantees that any of us are going to get the life we want.
But I couldn’t figure out how to say it without sounding preachy.
FWIW, I think the cost of medical school needs to be considerably less burdensome, but I don’t think it should come at the expense of future earnings.
i was in residency and fellowship for 9 years. my family survived very lean times for that time period while the people who trained for 3 or 4 years started reaping the benefits earlier.
they seem to have forgotten those times. do you have any idea how much more painful those last 5 years are?
although i make more than primary care docs now, compound interest working against you with hundreds of thousands in principal sucks. vacations are severely limited. small flexibility in schedule. come in at night regularly. missed family events. it isn’t all beautiful for specialists.
these people proposing ideas to limit payment have no idea about malpractice expense or tail coverage. or the stress of running your own business. well they have a limited idea that can be gleaned from reading, but not experience from living the dream. all they see is $$$ being spent on healthcare and that $$$ are the group least likely to organize effectively to fight a cut.
Oh my, no not every one makes the same sacrifices though anon 3:30. You don’t understand. My friends and I were the best and brightest in college. We all went different ways though. The sacrifice of training in medical school and residency is putting my friends who went to law school, dental school, chemical engineering firm, mechanical engineering firm, etc. to shame.
It is amazing how they get paid (note get paid, not just not pay tuition) and get to have free time on the weekends and at night. I am not saying I don’t expect to put in the normal 8-7 day that is typical of hard working people. I just get resentful when everyone else is getting paid for 8am-7pm extremely well and I am paying/not getting paid for my 4am-9pm.
These are just my observations. And I said earlier becuase of this I have grown distant from a lot of my friends because they have time that is actually free to go hang out with each other.
Anony 4:44,
“Not everyone makes the same sacrifices.” Say what? I sacrificed part of my 20s to chemotherapy and a stem cell transplant. I lost friends, disrupted my career and don’t have a cent to show for it. My friends were out having fun and I was home on the couch, too tired and too immune-compromised to do much of anything.
Sound familiar? I thought so.
My honest advice to you is to try to stop comparing yourself to your friends. Don’t let envy and resentment start to eat up your soul.
There are always going to be people who appear to be better off than you are, whatever “better off” means. There are also millions of people who are paid far less, work at demanding, menial jobs and have far fewer prospects in life.
I know the delayed gratification is really hard, but you can’t afford to buy into the comparison game of what “everyone else” is doing. It’s a game you cannot win.
I guess I’m sounding preachy now. Oh well. Too late to delete my comment.
>>”"Would you accept a lower salary if you could graduate from medical school debt free?”"
I did. I took an HPSP scholarship with the Navy and completed repayment by working for four years, at less pay than I would have made as a civilian for the same work. The tradeoff was a delay to my training (not something I recommend).
Do I think that was a fair tradeoff? I am not sure. Even though I wrote my last student loan payment (I still took some small loans) years before my colleagues who borrowed more heavily did, the constant dollar analysis I have read comparing the military route woth borrowing still favors the taking of loans rather than the service obligation.
The larger point is that payback was four years, not a career of lower income. So to answer the OP, I would take a lower income, but not for any longer a term than I already did.
“It is amazing how they get paid (note get paid, not just not pay tuition) and get to have free time on the weekends and at night.”
If you have friends in law who are getting paid anywhere near what a physician does and are just a couple years out of law school, they do not have much free time. Those top firms that pay the high salaries have very high billable hour requirements.
“Read the rest of her excellent analysis of physician salaries.”
Excuse me, but this is wanton socialist blather, not an analysis. Patently un-American. Please go practice in another country if you want to practice this way.
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